Disability is a Development Issue

Disability is a Development Issue

The World Health Organization (“WHO”) has pronounced disability as a “development issue, because of its bidirectional link to poverty: disability may increase the risk of poverty, and poverty may increase the risk of disability” and noted that “[a] growing body of empirical evidence from across the world indicates that people with disabilities and their families are more likely to experience economic and social disadvantage than those without disability”.[1]  WHO pointed out that “[t]he onset of disability may lead to the worsening of social and economic well-being and poverty through a multitude of channels including the adverse impact on education, employment, earnings, and increased expenditure related to disability” and went on to explain some of the specific issues for each of these channels as follows[2]:

  • Children with disabilities are less likely to attend school, which means that in later life they will have limited opportunities for human capital formation, be faced with reduced employment opportunities and overcome decreased productivity as they grow older.
  • People with disabilities are more likely to be unemployed and generally earn less even when employed, and both employment and income outcomes appear to worsen with the severity of the disability.  Persons with disabilities seeking work to escape from poverty are challenged by discrimination in employment, limited access to transport, and lack of access to resources to promote self-employment and livelihood activities.
  • People with disabilities and their families often have extra costs resulting from disability including costs associated with medical care or assistive devices and personal support and assistance.
  • Evidence confirms that households with a disabled member are more likely to experience material hardship relating to fundamental human rights including food insecurity, poor housing, lack of access to safe water and sanitation, and inadequate access to health care.

One of the strongest links between poverty and increased risk of disability is in the domain of health and WHO noted that a World Bank study of 56 developing countries[3] found that the poor experienced worse health than the better off and that “[p]overty may lead to the onset of a health conditions associated with disability including through: low birth weight, malnutrition, lack of clean water or adequate sanitation, unsafe work and living conditions, and injuries”.[4]  A related issue also mentioned by WHO was that persons in poverty with existing health conditions were more likely to become disabled because of those conditions because they lived in an inaccessible environment or otherwise lacked access to appropriate health and rehabilitation services.

Disability and the Millennium Development Goals

The UN Millennium Development Goals (“MDGs”) were eight goals that UN Member States agreed to try to achieve by the year 2015 when the UN Millennium Declaration was signed in September 2000.  The Declaration committed world leaders to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women and each MDG had targets set for 2015 and indicators to monitor progress from 1990 levels.[5]  While the MDGs were noteworthy, they drew criticism from WHO as demonstrating the lack of attention paid to “the widely acknowledged inter-connection between disability and poverty”, with WHO going on to note that “efforts to promote development and poverty reduction have not always adequately included disability” and that disability was not explicitly mentioned in the MDGs.  As time went by, and important events such as the adoption of the UN Convention on the Rights of Persons with Disabilities (“CRPD”) in 2006 occurred, a consensus emerged among experts that the MDGs would not be achieved if their policies, programs, monitoring and evaluation did not include persons with disabilities.[6] 

The UN noted that “[w]hile persons with disabilities make up ten per cent of the world’s population, disability is associated with twenty per cent of global poverty according to the World Bank’s findings” and called on the international community “urgently to act to mainstream disability in the MDG processes”.[7]  In its extensive 2011 report on disability and the MDGs, the UN declared: “The fact that persons with disabilities are not included in any of the MDGs’ Goals, Targets or Indicators represents a lost opportunity to address the pressing social, educational, health and economic concerns of millions of the world’s most marginalized citizens.  Indeed, this lack of inclusion is more than a lost opportunity—a growing body of opinion and data argues that unless persons with disabilities are included, none of the MDGs will be met.”[8]

A meeting of the United Nations Expert Group meeting on Mainstreaming Disability in MDG Policies, Processes and Mechanisms: Development for All was convened in Geneva in April 2009 to develop a “roadmap” for how disability could be included in the planning, monitoring and evaluation of all MDG related plans, programs and policies in international development currently in operation or in the planning stage.[9]  In 2011 the WHO wrote that “disability needs to be a higher priority, successful initiatives need to be scaled up, and a more coherent response is needed … [and] … [d]isability is a development issue, and it will be hard to improve the lives of the most disadvantaged people in the world without addressing the specific needs of persons with disabilities”.[10]  When the Millennium Development Goals Report 2015 was issued at the end of MDG period, the UN Secretary-General wrote that “[p]rogress tends to bypass women and those who are lowest on the economic ladder or are disadvantaged because of their age, disability or ethnicity”.[11] 

As attention turned from the MDGs to the 17 Sustainable Development Goals (“SDGs”) of the 2030 Agenda for Sustainable Development adopted by world leaders in September 2015 (and discussed below)[12], experts continued their guidance on how best to realize development goals by, for and with persons with disabilities.  For example, in 2015 Rohwerder cataloged various “best practices” recommended approaches for disability inclusive development and human responses to shortcomings in the realization of disabled persons’ human rights[13]:

  • Mainstreaming: Mainstreaming disability in development and humanitarian response means including people with disabilities in all aspects of development and humanitarian efforts and considering disability in all programming.  According to the UN Department of Economic and Social Affairs (“DESA”), mainstreaming disability is about “recognizing persons with disabilities as rights-holding, equal members of society who must be actively engaged in the development process irrespective of their impairment or other status, such as race; color; sex; sexual orientation; language; religion; political or other opinion; national, ethnic, indigenous or social origin; property; birth or age”[14].  According to Coe and Wapling, efforts to mainstream disability must begin with an analysis of relevant barriers and careful planning.[15]
  • “Twin-track” approach:   The “twin-track approach”, the most referenced approach by UN agencies, bilateral development agencies and NGOs for disability inclusive development, combines mainstreaming with disability-specific projects that are needed to achieve the full inclusion and participation of people with disabilities.[16]  
  • Raising awareness and changing attitudes/behaviors: A key first step toward more inclusion of disabled people in development work is challenging staff and community attitudes and promoting interaction with people with disabilities, a strategy that has been found to be effective in creating positive change in the attitudes and behavior of those involved in implementing programs and in better tailoring of programs and services to the needs of persons with disabilities.[17]  Steps should also be taken to bring disability into the political and social discourse in order to raise awareness of disability at organizational, community and institutional levels, which hopefully will promote more positive attitudes toward disability.[18]
  • Comprehensive accessibility: Comprehensive accessibility “ensures that physical, communication, policy and attitudinal barriers are both identified and addressed” and can be expected to lead to “an improved, participative economic and social environment for all members of society”.[19]
  • Reasonable accommodation:   Reasonable accommodation is defined in Article 2 of the CRPD as “necessary and appropriate modification and adjustments not imposing a disproportionate or undue burden, where needed in a particular case, to ensure to persons with disabilities the enjoyment or exercise on an equal basis with others of all human rights and fundamental freedoms”[20]  According to WHO, reasonable accommodation is important for mainstreaming and requirements for reasonable accommodation can be voluntary or mandatory and can include structural modifications to facilities; use of equipment with universal design features; communication in appropriate formats; modification of working times or arrangements; and alternative models of service delivery.[21]  
  • Participation:  DESA emphasized the importance of participation of disabled persons in development and humanitarian work and the need for “actively and meaningfully involving people with disability in all matters concerning them in the process of forming policies and programs”.[22]  Effective participation requirements involvement of all impairment groups, with due consideration for intersectionality with gender, age, ethnicity and other factors that can contribute to discrimination or exclusion[23]; involvement of disabled peoples organizations and participation by disabled persons themselves in the collection and analysis of relevant data.[24] 
  • Rights-based approach:  DESA and other have recommended and promoted a rights-based approach pursuant to which each mainstreaming initiative prioritizes systematic contribution to the implementation of the CRPD.[25]  Particularly important is legislation based on the principles of the CRPD, which WHO has applauded as playing an important role in enforcing rights, creating minimum standards in accessibility and ensuring participation.[26]
  • Community-based rehabilitation:  Community-based rehabilitation (“CBR”) is implemented through the combined efforts of various stakeholders (i.e., people with disabilities, their families, organizations and communities and government and non-governmental services) to equalize opportunities, reduce poverty and promote social inclusion of people with disabilities.[27]  While CBR has yet to be used extensively, early evidence shows that it can improve wellbeing for persons with disabilities and their families.[28]

In addition to the best practices listed above, successful disability inclusion cannot occur without organizational change among donors and development agencies.[29]  According to Wapling and Downie, “experience shows the most substantial gains [in disability inclusion] are made when donors and development agencies change the way disability is internally defined and understood, when they commit to approaching disability from a human rights-based perspective rather than an impairment-based one, and when the empowerment and support of disabled people’s organizations is central to their strategy”.[30]

Disability and the Sustainable Development Goals

The shortcomings relating to disability inclusion in the MDGs led to pressure from disabled people’s organizations and NGOs to specifically address disability in the SDGs, which include 169 targets and are to be universally applied to all and serve as a catalyst to countries to mobilize efforts to end all forms of poverty, fight inequalities and tackle climate change, while ensuring that no one is left behind.  While the SDGs are not legally binding, national governments are expected to take ownership and establish national frameworks for the achievement of the SDGs and countries have the primary responsibility for follow-up and review of the progress made in implementing the SDGs.  Provisions have also been made for monitoring and reviewing the SDGs using a set of global indicators developed by the UN Statistical Commission and adopted by the Economic and Social Council and the UN General Assembly.[31]

The work of advocates for people with disabilities contributed to the inclusion of eleven explicit references to the group in five of the 17 SDGs relating to education (SDG 4), decent work and economic growth (SDG 8), reducing inequality (SDG 10), sustainable cities and communities (SDG 11), and partnerships and goals (SDG 17), and the inclusion of persons with disabilities as vulnerable people by the SDGs extended the scope of references to persons with disabilities to targets related to poverty (1.3, 1.4 and 1.5), food (2.1), water and sanitation (6.2) and disaster situations (11.5).[32]  Since the SDGs were adopted, there has been continuous work on developing a framework for tracking SDG indicators related to achievement of goals and targets relevant to persons with disabilities including recommendations for disaggregating data by disability status for broadly stated goals and targets.[33]  An assessment of SDG indicators by the UN Economic and Social Commission for Western Asia revealed 41 mentions of the words “disability”, “vulnerable populations” or “disadvantaged groups” in the indicators, their targets and metadata, and the SDG Indicator Framework on Disability includes 69 indicators distributed over 14 SDGs.[34] 

In 2019 DESA published an extensive report (the “2018 Disability and Development Report”) detailing the progress that has been made with respect to realization of the SDGs by, for and with the persons with disabilities.[35]  According to the Executive Summary included in the report[36]: 

“The report shows that despite the progress made in recent years, persons with disabilities continue to face numerous barriers to their full inclusion and participation in the life of their communities. It sheds light on their disproportionate levels of poverty; their lack of access to education, health services and employment; and their underrepresentation in decision-making and political participation. This is particularly the case for women and girls with disabilities. The main barriers to inclusion entail discrimination and stigma on the grounds of disability; lack of accessibility to physical and virtual environments; lack of access to assistive technology, essential services and rehabilitation; and lack of support for independent living that are critical for the full and equal participation of persons with disabilities as agents of change and beneficiaries of development. Data and statistics compiled and analyzed in the present report indicate that persons with disabilities are not yet sufficiently included in the implementation, monitoring and evaluation of the SDGs.”

The 2018 Disability and Development Report called for “concrete action … to make persons with disabilities and their situations visible in policymaking and to build just and inclusive societies” and argued that “[t]his action should focus on the following four fronts[37]:

  • Addressing fundamental barriers causing exclusion of persons with disabilities including discriminatory laws and policies; lack of accessibility in physical and virtual environments; negative attitudes, stigma, and discrimination; lack of access to assistive technology and to rehabilitation; and lack of measures to promote the independent living of persons with disabilities.
  • Mainstreaming disability in the implementation of the SDGs particularly in the areas of social protection (target 1.3 to SDG 1 (no poverty)), education (SDG 4), employment (SDG 8) and basic services, including health-care services (SDG 3), water and sanitation (SDG 6), energy (SDG 7) and accessible infrastructural development in urban and rural environments, public spaces and facilities (SDG 11).[38]
  • Investing in the monitoring and evaluation of progress towards the SDGs for children, youths and adults with disabilities including establishing indicators to be collected and disseminated regularly to assess the situation of persons with disabilities and the challenges they face (such as lack of accessibility) and evaluate the progress of the policies and programs that have been implemented to promote disability inclusion.[39]
  • Strengthening the means of implementation of the SDGs for persons with disabilities: allocating adequate financial resources to enforcement of laws and implementation of policies, promotion of accessible technology, capacity-building to formulate disability-inclusive laws and policies and implement programs relating to the SDGs, policy and institutional coherence through national institutional mechanisms to promote the rights and inclusion of persons with disabilities, and formation of multi-stakeholder partnerships to ensure that development activities and programs include the perspectives and consider comprehensively the needs of persons with disabilities.

DESA argued that persons with disabilities “face persistent inequality in social, economic and political spheres and are disadvantaged in all areas covered by the SDGs”, noting significant gaps between persons with and without disabilities with respect to income poverty, the ability to afford a meal with protein every second day, experiencing good health, literacy rates, employment-to-population ratios, accessing essential services (e.g., water and sanitation, energy and the Internet) and political participation.[40]  DESA called out discrimination as a major cause of exclusion of persons with disabilities and argued that combating discrimination was key to the reduction of inequality for persons with disabilities.  According to DESA, some of the key areas where changes in discriminatory laws and policies were required included regulation of the right to marry, legal capacity and political participation and countries were urged to ensure access to assistive technology for persons with disabilities for them to live independently and fully participate in society.  DESA also called for de-institutionalizing, noting that “[p]ersons with disabilities living in institutions remain excluded from society and are often unable to obtain education, to exercise the right to vote and to make their own decisions”.[41]

Several years later, in an updated report on disability and development (the “2024 Disability and Development Report”), DESA declared[42]:

“Six years away from the deadline for the 2030 Agenda, the Disability and Development Report 2024 shows that persons with disabilities are being left behind. Progress for persons with disabilities on 30 per cent of targets of the SDGs is insufficient; on 14 per cent, the target has been missed or progress has stalled or gone into reverse. These include targets on access to financial resources, health care, water and ICT as well as on building resilience of persons with disabilities during disasters and other emergencies. A mere 5 indicators are on track, i.e., with progress consistent with achieving their respective targets for persons with disabilities by 2030 – these include remarkable progress in education laws on equal access, disaster early warnings in accessible formats, online services for persons with disabilities, government ministries accessible for persons with disabilities and monitoring of bilateral aid dedicated to disability inclusion.”

According to the 2024 Disability and Development Report:

“The way things are going, the world will not achieve the SDGs by, for and with persons with disabilities by 2030. Depending on the target, progress needs to accelerate to 2 to 65 times faster. Accelerations are particularly needed in making physical and virtual environments accessible for persons with disabilities, in adopting anti-discrimination legislation, in expanding social protection and in implementing measures to guarantee the safety and protection of all persons with disabilities during disasters and emergencies.”

To learn more, read my full chapter on Disability and Development.

Notes 

[1] World Report on Disability (Geneva: World Health Organization, 2011), 10 (citing A. Sen, The Idea of Justice (Cambridge MA: The Belknamp Press of Harvard University Press, 2009).

[2] Id. (citations omitted).

[3] DR Gwatkin et al, Socioeconomic differences in health, nutrition, and population within developing countries (Washington DC: World Bank, 2007) (Working Paper 30544).

[4] World Report on Disability (Geneva: World Health Organization, 2011), 10 (citations omitted).

[5] For further information on MDGs, see Millennium Development Goals (World Health Organization) and Millennium Development Goals (MDG Monitor).

[6] For further discussion of the CRPD and the human rights of persons with disabilities, see A. Gutterman, Ageism and Disability (Oakland CA: Older Persons’ Rights Project, 2023).

[7] The Millennium Development Goals (MDGs) and Disability (UN Department of Economic and Social Affairs).

[8] Disability and the Millennium Development Goals: A Review of the MDG Process and Strategies for Inclusion of Disability Issues in Millennium Development Goal Efforts (UN Department of Economic and Social Affairs, 2011), viii.

[9] Expert Group Meeting on Mainstreaming Disability in MDG policies, processes and mechanisms: Development for All (UN Department of Economic and Social Affairs—Disability) (for summary of recommendations, see The Millennium Development Goals (MDGs) and Disability (UN Department of Economic and Social Affairs) (also including a comprehensive set of links to other reports relating to the integration of the rights of disabled persons into the MDGs and other UN instruments).

[10] World Report on Disability (Geneva: World Health Organization, 2011), 12.

[11] The Millennium Development Goals Report 2015 (New York: United Nations, 2015), 3.  The Report also noted: “Millions of people are being left behind, especially the poorest and those disadvantaged because of their sex, age, disability, ethnicity or geographic location”.  Id. at 8.

[12] For further discussion of SDGs, see A. Gutterman, Sustainability Standards and Instruments (New York: Business Expert Press, 2021), 51-62 and A. Gutterman, “SDG-Related Reporting” in A. Gutterman, Sustainability Reporting and Communications (New York: Business Expert Press, 2021), 77-103.

[13] The catalog of “best practices” and related citations in this section are adapted from B. Rohwerder, Disability Inclusion: Topic guide (Birmingham UK: GSDRC, University of Birmingham, 2015), 38-42.

[14] Best practices for including persons with disabilities in all aspects of development efforts (New York: UN Department of Economic and Social Affairs, 2011), 5.

[15] S. Coe and L. Wapling, “Practical lessons from four projects on disability-inclusive development programming”, Development in Practice, 20(7) (2010), 879, 884.

[16] Best practices for including persons with disabilities in all aspects of development efforts (New York: UN Department of Economic and Social Affairs, 2011), 5; Inclusion made easy: A quick program guide to disability in development (Bensheim: CBM, 2012), 3; and Disability, Poverty and Development (London: Department for International Development, 2000), 11.  One commentator noted that often the balance is tipped towards disability-specific services in international development, rather than mainstreaming.  See K. Al Ju’beh, Disability inclusive development toolkit (Bensheim: CBM, 2015), 55-56.

[17] S. Coe and L. Wapling, “Practical lessons from four projects on disability-inclusive development programming”, Development in Practice, 20(7) (2010), 879, 881-882; S. Coe, “More practical lessons from five projects on disability-inclusive development”, Development in Practice, 22(3) (2012), 400, 404-405; P. Bruijn, B. Regeer, H. Cornielje R.  Wolting, S. van Veen and N. Maharaj, Count me in: Include people with disabilities in development projects – A practical guide for organisations in North and South (Veenendaal: LIGHT FOR THE WORLD, 2012), 90; K. Al Ju’beh, Disability inclusive development toolkit (Bensheim: CBM, 2015), 50; and The state of the world’s children 2013: Children with disabilities (New York: UNICEF, 2013), 112.

[18] Best practices for including persons with disabilities in all aspects of development efforts (New York: UN Department of Economic and Social Affairs, 2011), 8; Inclusion made easy: A quick program guide to disability in development (Bensheim: CBM, 2012), 3; and The state of the world’s children 2013: Children with disabilities (New York: UNICEF, 2013), 112.

[19] Inclusion made easy: A quick program guide to disability in development (Bensheim: CBM, 2012), 15 and 17.

[20] A/RES/61/106

[21] World Report on Disability (Geneva: World Health Organization, 2011), 74, 241 and 264.

[22] Best practices for including persons with disabilities in all aspects of development efforts (New York: UN Department of Economic and Social Affairs, 2011), 7.

[23] Best practices for including persons with disabilities in all aspects of development efforts (New York: UN Department of Economic and Social Affairs, 2011), 7; S. Coe and L. Wapling, “Practical lessons from four projects on disability-inclusive development programming”, Development in Practice, 20(7) (2010), 879, 883; and K. Al Ju’beh, Disability inclusive development toolkit (Bensheim: CBM, 2015), 51.

[24] Rohwerder noted that “DPOs can play an important role in this process: donors should consider helping to address DPOs’ capacity gaps, which are sometimes large” (citing L. Wapling and B. Downie, Beyond charity: a donor’s guide to inclusion – Disability funding in the era of the UN Convention on the Rights of Persons with Disabilities (Boston: Disability Rights Fund, 2012), 39-47; Best practices for including persons with disabilities in all aspects of development efforts (New York: UN Department of Economic and Social Affairs, 2011), 7 and others).

[25] Best practices for including persons with disabilities in all aspects of development efforts (New York: UN Department of Economic and Social Affairs, 2011), 7.

[26] World Report on Disability (Geneva: World Health Organization, 2011).

[27] Id. at 13.

[28] V. Mauro, M. Biggeri, S. Deepak and J-F. Trani, “The effectiveness of community based rehabilitation programs: An impact evaluation of a quasi-randomised trial”, Journal of Epidemiology & Community Health, 68 (2014), 1102; and M. Biggeri, V. Mauro, S. Deepak, J-F. Trani and P. Ramasamy, “Do community-based rehabilitation programmes promote the participation of persons with disabilities? A case control study from Mandya district, in India”, Disability & Rehabilitation, 36(18) (2014), 1508..

[29] P. Bruijn, B. Regeer, H. Cornielje R.  Wolting, S. van Veen and N. Maharaj, Count me in: Include people with disabilities in development projects – A practical guide for organisations in North and South (Veenendaal: LIGHT FOR THE WORLD, 2012), 8 and 64.

[30] L. Wapling and B. Downie, Beyond charity: a donor’s guide to inclusion – Disability funding in the era of the UN Convention on the Rights of Persons with Disabilities (Boston: Disability Rights Fund, 2012), 13.

[31] DESA publishes an annual global overview of progress on the implementation of the 2030 Agenda for Sustainable Development, using the latest available data and estimates. It tracks the global and regional progress towards the 17 SDGs with in-depth analyses of selected indicators for each SDG.

[32] B. Rohwerder, Disability Inclusion: Topic guide (Birmingham UK: GSDRC, University of Birmingham, 2015), 10-11 (noting also that people with disabilities are included whenever “vulnerable” is referenced and pointing out concerns about the lack of specific references to people with disabilities in relation to health and gender).

[33] See, e.g., Disability indicators for the SDGs (UN DESA/DSPS/Secretariat for the Convention on the Rights of Persons with Disabilities, October 2015).

[34] Disability-SDG Framework Indicators.  See also ESCWA Disability Framework: 115 indicators to bridge the gap between policy and statistics (UN Economic and Social Commission for Western Asia, June 2019).

[35] Disability and Development Report 2018 (New York: UN Department of Economic and Social Affairs, 2019).

[36] Id. at 1.

[37] Id. at 18-19.

[38] The report also mentioned the need to reduce the persistent inequality in social, economic and political spheres faced by persons with disabilities (SDG 10), build the resilience of persons with disabilities and reduce their exposure to and impact from climate-related hazards and other shocks and disasters (targets 1.5 to SDG 1 (no poverty), 11.5 to SDG 11 (sustainable cities and communities) and SDG 13 (climate action)) provide access to justice for persons with disabilities (SDG 16 (peace, justice and strong institutions) and increase the availability of disaggregated data by disability (target 17.18 to SDG 17 (partnerships for the goals)).

[39] See Global indicator framework for the Sustainable Development Goals and targets of the 2030 agenda for sustainable development (New York: United Nations, 2018) (explaining how SDG indicators should be disaggregated, where relevant, by income, sex, age, race, ethnicity, migratory status, disability and geographic location, or other characteristics, such as “8.5.1 Average hourly earnings of employees, by sex, age, occupation and persons with disabilities”).

[40] Disability and Development Report 2018 (New York: UN Department of Economic and Social Affairs, 2019), 13.

[41] Id.

[42] Disability and Development Report 2024: Accelerating the realization of the Sustainable Development Goals by, for and with persons with disabilities (Executive Summary) (UN Department of Economic and Social Affairs, June 2024).

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