3. Disability and poverty

Introduction

For decades the international disability movement has been saying that disability is a cause of poverty, that poverty often leads to disability and that disabled people are among the poorest of the poor in any country. However, it is only recently that a solid platform has been found from which to advance this argument. This has come about through the promotion of the UN's Millennium Development Goals (MDGs), which have prioritised poverty reduction in developing countries, and the establishment by the World Bank and International Monetary Fund of various new aid instruments and procedures, also built ostensibly around reducing poverty.

Unfortunately, those who constructed this platform did so without making disability part of the framework. Disability is not, for example, explicitly mentioned in any of the eight MDGs or the documentation for the new aid instruments or procedures (see Section 3). It has been left to disabled people's organisations (DPOs) and their allies to campaign to get disability onto the development/poverty agenda.

This process is ongoing and has been considerably facilitated by the World Bank, whose former president was an outspoken disability champion. In 2002 a Disability and Development Team was set up at the Bank. Its members have been proactive in supporting research into disability and poverty and finding ways to get DPOs more involved in Poverty Reduction Strategy Papers, one of the main new aid instruments (see Mainstreaming Disability in Development >>). They have also been pushing hard to get the tackling of disability issues recognised as essential for achieving almost all of the MDGs.

The links between poverty and disability figured prominently in the Disability Knowledge and Research Programme. They were a priority issue in all of the many reports by the Disability Policy Officer and the subject of one of the Programme's major research projects.

Disability and poverty: trying to capture illusive concepts

Although the various connections between disability and poverty might appear to be relatively straightforward, the Disability KaR paper Disability, poverty and the 'new' development agenda (Ref. C5), has argued that the linkages are in fact deceptively complicated. The hard statistical evidence is also limited and very sketchy. The report poses some fundamental questions about how the two concepts of disability and poverty are understood and what that understanding means in terms of an analysis of their convoluted interrelationship.

The researchers point out that disability and poverty are highly contested political concepts. Furthermore, because different meanings are used, and there is insufficient care taken to recognise this, commentators are often at cross purposes when debating the issues. For example, disability and impairment are frequently conflated: the latter is confused with how a person with an impairment becomes disabled through complex social processes. As discussed in the Disability KaR paper Data and statistics on disability in developing countries (Ref. D5), this definitional problem is compounded by statistical surveys which invariably fail to '… detach the issue of disability prevalence from an impairment-based approach to disability.' Poverty too throws up similar, and in many respects more multifaceted, uncertainties of meaning.

Why are so many disabled people poor? Why are so many poor people disabled?

Minefield warning in Cambodia

Bearing in mind the points made above, the Programme's Policy Officer's country reports on Rwanda, Cambodia and India (Refs A4-6) provide excellent case studies of the social factors that make it more likely that poor people will contract impairments and why people with impairments are likely to become or remain poor.

Disabled people struggle to find employment in all three countries. Having a physical impairment makes it difficult to work in the agricultural sector, which dominates in all the economies. Vocational training opportunities are limited, tend to be in urban areas and are not generally linked to gainful employment. Because they are seen as presenting a high risk, disabled people are also usually denied access to micro-credit schemes.

It was found that in Cambodia poor people tend to live near areas that had been mined, are forced to use more risky means of transport, have more dangerous jobs and cannot access health care so that minor illness or injury can become more permanent impairments. Malnutrition, which makes having a whole range of impairments more likely, is also closely associated with being poor.

However, another Disability KaR report from Cambodia, Developing participatory rural appraisal approaches with disabled people (Ref. B3), found that '…the highest disability (impairment) prevalence rate appears to be in the least isolated village with the best social and economic opportunities, which raised questions about the links between poverty and disability.' This mirrors the way that the prevalence of impairment is significantly higher in the more economically privileged countries of the North and highlights how complex the poverty-disability-poverty question really is.

Disability and social exclusion

The prevention of impairment, through mine clearance, inoculation, better health care and/or nutrition, is vital in developing countries, but needs to be clearly distinguished from interventions aimed at combating the social exclusion and denial of human rights that disable people with impairments.

The reality and extent of the social exclusion of disabled people is brought out starkly in the three country reports mentioned above, as well as the Policy Officer's final report, Disability, poverty and the Millennium Development Goals (Ref. A7).

Conclusion

On this and related topics, the Disability KaR Programme's research has provided ample evidence of the interconnected and multi-layered symbiotic relationship between poverty, impairment and disability. This is succinctly summed up in the report Disability, poverty and the Millennium Development Goals (Ref. A7):

• Disabled people are typically among the very poorest, they experience poverty more intensely and have fewer opportunities to escape poverty than non-disabled people.
• Disabled people are largely invisible, are ignored and excluded from mainstream development.
• Disability cuts across all societies and groups. The poorest and most marginalised are at the greatest risk of disability. Within the poorest and most marginalised, disabled women, disabled ethnic minorities, disabled members of scheduled castes and tribes, and so on will be the most excluded.
• DFID cannot be said to be working effectively to reduce poverty and tackle social exclusion unless it makes specific efforts to address disability issues.