What needs to change...and Why!
More than a billion people are estimated to live with some form of chronic disability, or about 15% of the world’s population. The number of people with disabilities is growing – there is a global increase in chronic health conditions such as diabetes, cardiovascular diseases and mental health disorders, which all influence the nature and prevalence of disability.
The removal of barriers for people with disabilities is therefore even more important, as these barriers (such as negative attitudes, lack of provision of services, inaccessibility to infrastructure, lack of consultation and involvement) contribute to the disadvantages experienced by people with disabilities. For example, people with disabilities often:
- Have poorer health outcomes: people with disabilities may experience greater vulnerability to preventable secondary conditions and co-morbidities, untreated mental health conditions, poor oral health, higher rates of HIV infection, higher rates of obesity, and premature mortality;
- Have lower educational achievements: children with disabilities are less likely to start school than their peers without disabilities. They also have lower rates of remaining in school, of being promoted or transitioning to post-school education.
- Are less economically active: people with disabilities have lower employment rates than people without disabilities. Where people with disabilities are employed, they commonly earn less than their counterparts without disabilities.
- Experience higher rates of poverty: households without a person with a disability have higher rates of poverty than households within a member with a disability. As a group and across settings, people with disabilities have worse living conditions and fewer assets. Poverty may exacerbate disability through malnutrition, poor health care, and dangerous working or living conditions. Cyclically, disability may lead to poverty through lost earnings due to lack of employment or underemployment, and through the additional costs of living with a disability, such as extra medical, housing and transport costs.
- Cannot always live independently or participate fully in community activities: Reliance on institutional solutions, lack of community living, inaccessible transport and other public facilities, and negative attitudes leave people with disabilities dependent on others, as well as leaving them isolated from mainstream social, cultural and political opportunities.
It is indefensible from legal and human rights perspectives that people with disabilities are extensively excluded from society. This being said, based on significant research and widely published literature from the UN and many national and international organisations and agencies, the evidence base as to the economic benefit of inclusive development, particularly within education, employment and health care, is becoming far more highly recognizable.
Exclusion from education may lead to lower employment and earning potential among people with disabilities. Not only does this make individuals and their families more vulnerable to poverty, but it can also limit national economic growth. For example:
- In Bangladesh, reductions in wage earnings attributed to lower levels of education among people with disabilities were estimated to cost the economy USD 54 million per annum.
- In Nepal, the inclusion of people with sensory of physical limitations in schools was estimated to generate wage returns of 20%.
- In China, estimates indicated that each additional year of schooling for people with disabilities lead to a wage increase of 5% for rural areas and 8% for urban areas.
Also, increasing access to education can have positive impacts in such areas as crime, control of population growth, health, citizen participation and gender empowerment, which in turn have financial/ economic and social consequences.
In addition to challenges accessing formal employment, people with disabilities may also face barriers to informal work and self-employment. Additionally, caregivers may forgo work opportunities to support family members with disabilities.
- In Bangladesh, estimates indicated that exclusion of people with disabilities from the labour market results in a total loss of USD 891 million per annum, and that income losses among adult caregivers adds an additional loss of USD 234 million per annum.
- In Morocco, lost income due to exclusion from work was estimated to result in national losses of 9.2 billion dirhams (approximately USD 1.1 billion).
- In South Africa, lost earnings averaged USD 4,798 per adult with severe depression or anxiety disorder per annum (about half of GDP per capita) totalling USD 3.6 billion when aggregated to the national level.
- In Pakistan, it was estimated that rehabilitating people with incurable blindness would lead to gross aggregate gains in household earnings of USD 71.8 million per annum.
Also, it has been proven that employees with disabilities have greater retention rates, higher attendance and better safety records and matched productivity compared to employees without a disability. These savings can generate substantial gains:
- In the US, concerted efforts by major companies Walgreens and Verizon to employ significant numbers of people with disabilities saw gains of 20% increase in productivity and a 67% return on investment, respectively .
Inability to access and receive appropriate timely health care may result in continuously poor or worsening levels of functioning among people with disabilities – including the development of additional disabling conditions – that lead to higher personal and societal medical and productivity costs in the long term. Moreover, failure to include people with disabilities in public health interventions can impede the effectiveness and efficiency of these programmes. As a result of exclusion, people with disabilities may experience avoidable medical/ productivity costs and governments may end up spending more in parallel care and treatment programmes for preventable health conditions.
Poor health can have negative consequences for both education and employment. For example, consistently poor health can lead to low educational attainment, which in turn is strongly linked to lower lifetime earning potential. Additionally, poor health can decrease job productivity, and if persistent, can lead to job losses or forced reduction in hours. However, efforts to improve the health status of individuals with disabilities can lead to greater participation in employment and education, resulting in economic gains.
- In China, a randomized control trial involving individuals with schizophrenia found that those who received individualised family-based interventions (consisting of counselling and drug supervision) worked 2.6 months more per year than those who did not receive the treatment.
- In Bangladesh, children who were provided with assistive devices (hearing aids or wheelchairs) were more likely to have completed primary school compared to those who did not receive any supports.
“A world that recognizes the rights of the disabled, ensures that people with disabilities can be productive members of their communities and nations, and provides an inclusive and accessible environment, is a world that will benefit all of us – with or without disabilities.” Ban Ki-moon, Secretary-General of the UN (2013).
 World Bank, 2008, Project appraisal document on a proposed credit to the People’s Republic of Bangladesh for a disability and children-at-risk project, Washington.
 Lamichhane K, 2013, Disability and barriers to education: evidence from Nepal, Scandinavian Journal of Disability Research,15(4): 311-24.
 Liao J, Zhao J, 2013, Rate of Returns to Education of Persons with Disabilities in Rural China.
 World Bank, 2008, Project appraisal document on a proposed credit to the People’s Republic of Bangladesh for a disability and children-at-risk project project, Washington.
 Collective for the promotion of the rights of people with disabilities, 2011, Study on the economic cost of exclusion from labor market of people with disabilities in Morocco.
 Lund C, Myer L, Stein DJ, Williams DR, Flisher AJ, 2013, Mental illness and lost income among adult South Africans, Society of Psychiatry and Epidemiology, 48(5): 845-51.
 Australia Chamber of Commerce and Industry, 2012, Employ outside the box - the business case of employing people with disabilities, Canberra.
 International Labour Organization, 2011, Disability in the Workplace and the ILO Global Business and Disability Network 2011.
 Houtenville A, Kalargyrou V, 2012, People with Disabilities Employers’ Perspectives on Recruitment Practices, Strategies, and Challenges in Leisure and Hospitality, Cornell Hospitality Quarterly, 53(1): 40-52.
 McIntyre D, Thiede M, Dahlgren G, Whitehead M, 2006, What are the economic consequences for households of illness and of paying for health care in low-and middle-income country contexts? Social Science & Medicine, 62(4): 858-65.
 Xiong W, Phillips MR, Hu X, Wang R, Dai Q, Kleinman J, et al, 1994, Family-based intervention for schizophrenic patients in China. A randomised controlled trial, The British Journal of Psychiatry, 165(2): 239-47.
 Borg J, Ostergren PO, Larsson S, Rahman AA, Bari N, Khan AN, 2012, Assistive technology use is associated with reduced capability poverty: a cross-sectional study in Bangladesh, Disability & Rehabilitation Assistive Technology, 7(2): 112-21.
 World Health Organisation, 2011, World Report on Disability, World Health Organisation, Geneva.