Disability and development: an overview of the issues

Defining disability

What is disability? Trying to define it is a complex and controversial matter. It is important to consider the preferences of disabled people themselves, and to bear in mind that acceptable terminology changes over time, and from one culture to another. Two key terms – 'impairment' and 'disability' – are often used synonymously. However, their meanings are different, and it is important to make a distinction between them. Impairment has been defined as 'lacking all or part of a limb; having a defective limb, organ or mechanism of the body'. Some disabled campaigners question the use of this term, because of its negative implications; they prefer the more neutral term 'condition'. A condition may or may not be perceived as an impairment and may or may not restrict one's ability to function.

In contrast, the term disability, as used by disabled people's organisations (DPOs), emphasises society's denial of the human rights of the person with the impairment. In the words of Disabled Peoples' International: 'Disability is the disadvantage or restriction of activity caused by contemporary social organisation, which takes little or no account of people who have impairments, and thus excludes them from the mainstream of social activities.'

The distinction between the two terms is neatly summarised in a discussion paper issued by the UK government's Department for International Development: 'Disabled people have long-term impairments that lead to social and economic disadvantages, denial of rights, and limited opportunities to play an equal part in the life of the community.'

Societies may differ in their treatment of disabled people or in the way in which discrimination is expressed, but in general the marginalisation of disabled people is international and irrespective of social class.

Three major types of discrimination have been identified: attitudinal, environmental, and institutional. Disabled people may be socially excluded by attitudes of fear and ignorance on the part of non-disabled people, who may use negative and pejorative language about them; or they may be excluded from society because of generally low expectations of what disabled people can achieve. Environmental discrimination occurs where public services, buildings, and transport are not designed with access for disabled citizens in mind. Institutional discrimination occurs where the law discriminates (explicitly or by omission) against the rights of disabled people, making them in some way second-class citizens – without the right to vote, to own land, to attend school, to marry and have children.

The prevalence of impairment

The United Nations Development Programme (UNDP) estimates that in 1990 one in 20 of the world's population had a moderate to severe impairment (either physical or mental); the proportions ranged from 4.5 per cent in 'developing' areas to 7.7 per cent in 'developed' countries. The World Health Organisation, surveying the whole range of impairments, from mild to severe, estimates that between 10 and 15 per cent of the population of 'developing' areas are affected, with higher levels in affluent countries. Detailed surveys indicate wide variations in the prevalence of impairments within and between countries, depending on a range of factors. For example, endemic river-blindness may affect many people within a particular area; in populations with large numbers of older people, conditions caused by the normal process of ageing are more prevalent; where armed conflict has included use of anti-personnel mines in rural areas, exceptionally high numbers of amputees may be found.

High mortality rates among children and young people with disabilities reduce the recorded incidence of impairment; yet, even if those who have died prematurely are excluded from the estimates, disabled people form a substantial minority of any population. If, in addition, we consider the families of disabled people, their carers, and others who are seriously affected by disability, then in some parts of the world the majority of the population may be affected by disability.

Disability, gender, and poverty

There exists a vicious cycle that links poverty and disability. Poverty frequently causes disability, or makes its effects worse, by virtue of factors such as malnutrition, inadequate housing, dangerous work in hazardous conditions, poor-quality medical treatment, and inadequate access to services. Disabled people are likely to face barriers to their inclusion in society, to educational opportunities, and to their access to health care and employment, which in turn will perpetuate their poverty. Families with a disabled member also face barriers and are likely to experience a greater degree of poverty than similar families without disabled members.

The need to care for a disabled family member makes demands upon other members and reduces the time available to them for economic activity or skills development. Disability has a disproportionate impact on males and females: in developing countries, most of the caring, as well as much of the production, is done by women, and girls are frequently withdrawn from school to look after a disabled brother or sister. Although in global terms 51 per cent of disabled people are women, disabled girls and women have even less access to education, health care, and employment than disabled boys and men have. Disabled women are doubly discriminated against: as women, and as people with impairments. They are often invisible to the providers of health care, and particularly reproductive-health care, yet they are also the frequent victims of sexual abuse.

Discrimination against disabled people is compounded if they belong to an ethnic minority or other marginalised group. But irrespective of their social class, or their religious or ethnic identity, disabled people around the world are likely to be poorer in terms of money, power, and rights, than...