23 February 2012

People with disabilities

Rationale

It is estimated that there are more than 600 million people with disability in the world (WHO). This represents between 18 and 20% of the world’s population. When the impact on families and carers is also considered, approximately 25% of the world’s population is affected by disability.. There is a strong correlation of impairment and ageing, hence it is estimated that the incidence of disability will rise as the baby-boomer generation age.

In addition, improvements in the quality of life for people with chronic illness and disability as well as advances in medicine are prolonging life in the face of previously life threatening situations and raising the incidence of disability particularly in industrialised countries. For example many babies born prematurely now survive often with significant disability. People are more likely to survive serious accidents and then live with head injury, spinal cord injuries or other impairments.

In the majority of the non-industrialised world, the incidence of disability is particularly high. War, famine, disasters all contribute to injury, impairment and disability. Land mines account for vast numbers of people with disability chiefly in Africa and Asia. The correlation of disability and poverty is well known and indeed constitutes a major focus for many international projects (Braithwaite, Carroll, Mont & Peffley, 2008). Many people with disability in the developing world live on less than US$1 per day.

‘… disabled people are also more likely than other people to live in grinding poverty. More than 1.3 billion people worldwide struggle to exist on less than [US]$1 a day, and the disabled in their countries live at the bottom of the pile.’ James D. Wolfensohn, former president of the World Bank, 2002

The human rights of people with a disability were first identified as a priority in the 1970s with the UN Convention on the Rights of the Mentally Retarded in 1975. Efforts to bring issues for people with a disability on global scale have continued with the most recent Convention on the Rights of Persons with Disability being passed in December 2006. This instrument has had a major impact. The CRPD provides clear directions and guidelines for legislative change, policy development and implementation for those governments and states ratifying the convention and Optional Protocol.

Social workers work with individuals with a disability, with families who have a child or family member with a disability as well as with communities both domestically and internationally. Our work in these spheres encompasses, direct practice, group work, community development, policy practice, research and advocacy. Social workers have played key roles in the development of antidiscrimination legislation, policies that support persons with disability and the development of disability programs. Social workers work alongside people with disabilities and families to realise social inclusion, community living, employment, family support, and rehabilitation. A policy statement on persons with disability therefore is a key platform for IFSW.

Background

The World Health Organization (WHO) estimates that there are around 600 million persons with disabilities. Other estimates are at 650 million. These cover many types and degrees of impairments. The day to day life of around 25 per cent of the world’s population is affected by disability. There is a strong correlation of impairment and ageing, hence it is estimated that the incidence of disability will rise as the baby-boomer generation age. In the majority world the correlation of poverty and disability is well known.

The history of how people with disabilities are treated is marked by marginalisation, discrimination, profound exclusion, and ultimate extermination. Throughout the industrialised world people with disabilities have experienced marginalisation, segregation, stigma and social exclusion. In the developing world attitudes to disability vary according to social norms, religious beliefs and cultural values. Some impairments are not viewed negatively in some cultures for example. However, most people with disability have been viewed in stigmatised ways.

Historically, people with disabilities were placed in large institutions where they remained cut off from family, isolated from society and subjected to often brutal treatment. Following a medical model of disability, people with disabilities were typically regarded as objects to be fixed by medical treatment, as objects of charity to be rendered welfare or as a burden of care. Many of these values are still prevalent today.

The advent of the disability rights and community living movements in the latter part of the 20th century brought about a number of changes whereby people with disabilities started to be regarded as active and participating members of society. However, it is still the case that most people with disabilities are still disadvantaged socially, economically, educationally and vocationally.

Definitions

Disability is a contested concept and definitions have varied over history and according to social norms. There is considerable debate as to what is disability and who are the disabled. Later models of disability distinguished between the various components of disability and for the first time differentiated between the objective impairment, the resulting level of functioning (disability) and the social components that handicap the individual. Impairments can be physical, sensory and cognitive and also include physical, mental and chronic illness. The social model of disability emphasises the perspective that disability is created through structural barriers and is thus created by society while individual, medical models have viewed disability as something inherent in the person.

The CRPD states:

Disability is an evolving concept, and that disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders full and effective participation in society on an equal basis with others. Disability thus results from an interaction between a non-inclusive society and individuals.

Persons using a wheelchair might have difficulties gaining employment not because of the wheelchair, but because there are environmental barriers such as inaccessible buses or staircases which impede access, as well as attitudinal barriers that discriminate against people with disabilities and hinder their full participation in society.

Human rights and people with disability

The rights of people with disability have been an ongoing issue both in terms of international legislative initiatives as well as through disability rights movements. Most important of international instruments and events are:
the UN Declaration on the Rights of Mentally Retarded Persons (1971),
the Declaration on the Rights of Disabled Persons in 1975,
the International Year for Disabled Persons in 1981,
World Programme of Action concerning Disabled Persons (UN, 1982), and
the United Nations Decade of Disabled Persons (1983_1992).

Culmination of all these is the Convention on the Rights of Persons with Disabilities of 2006, which has now been signed by more than 144 countries. In the 20th and 21st centuries a number of industrialized countries made laws to minimize the discrimination of people with disability (to guarantee the rights of people with disability) . Alongside this legislation there has been a concerted effort to improve the lived experiences of people with disabilities. This has resulted in policies that aim to reduce institutional care and in its place promote community living. There have been many questions and issues around community living. While espoused as an ideal, its implementation has not necessarily delivered quality outcomes for all people with disabilities.

Poverty

Throughout the world, the links between poverty and disability are well documented and deeply concerning, though this is particularly stark in the developing world. It is estimated that approximately 80 per cent of the world’s persons with disabilities live in low-income countries – the majority are poor and cannot access basic services. Only 2 per cent of children with disability in the developing world receive any education or rehabilitation. It is a special need, that the interests and needs of children with disabilities should be addressed in the work of all ministries and other responsible bodies. Social workers have to consider that there is a feminization of poverty especially women with disabilities, who are marginalized within an already marginalized group. Of women in poverty those with disabilities are frequently the poorest.

Education

The education of children with disabilities has been absent or minimal in some contexts and often involves segregated settings in many countries. Thus the social exclusion of children begins at an early stage with children being placed in parallel education systems. Later this is reflected by low numbers of persons with disabilities achieving tertiary education thus denying them many employment opportunities.

Employment

In the industrialized world, poverty is directly related to the low rates of employment for people with disability. For example, 17 per cent of Europe’s general population and about 15 per cent of the working population suffer from a disability or chronic illness. People with disabilities are reported to have twice the rate for non-participation in the labour market as compared to persons without disabilities. The unemployment rate for persons with a severe disability is about three times the level for persons without disabilities. Workers with disability typically receive a lower wage than others. Often people with disabilities need a specially modified working environment but employers are not willing to undertake such modification. This is a form of attitudinal discrimination so often experienced by people with disability.

People with intellectual disability

People with intellectual disabilities constitute a significant number of disabled persons. They have particular issues in that they are often more vulnerable to exploitation and victimisation. People with intellectual disability experience health inequalities compared with the general population. Although their life expectancy is increasing it remains much lower than the rest of the population. Additionally people with intellectual disabilities have higher level of health needs than others which are often unrecognised and experience barriers in accessing health and social services. People with intellectual disabilities are often placed in psychiatric hospitals which are inappropriate to their needs. There is now debate around the rights and legal capacity of people with intellectual or cognitive impairments and how can they best be protected while maintaining human dignity and worth and self determination.

Families

Many families are the key support for children with disabilities and for adults requiring supports – especially adults with intellectual disabilities and higher support needs. Family support services are vital for these families and require services from specially trained social workers.

People with emotional impairments

Individuals identified as having an emotional impairment manifest problems primarily in the affective domain. Often persons with an emotional impairment especially children cannot profit from learning experiences without additional education support.

They are unable to build or maintain satisfactory interpersonal relationships in school or in the work place. What are seen as inappropriate behaviours, lead to misunderstanding in schools at home and at the work place. In Germany children with emotional impairments are often sent to an educationally “subnormal” school.

Disability across the life span

The needs of persons with disability change over the life span from children through to young adulthood to adulthood and ageing. Programs and services need to reflect those changes. Early intervention is crucial for all aspects for disability programs and services. Women with disabilities experience deeper discrimination as witnessed by even lower rates for employment than men with disabilities and higher rates of abuse and violence.

Summary

There has been a greater recognition of the rights of people with disabilities and their rightful inclusion in society and community. However, social exclusion still exists on many levels often implicitly in social attitudes and values. Social inclusion has become a major international agenda and this must incorporate the input and participation of persons with disability of all ages and all world communities.

Policy Position

Social workers are strategically positioned to develop, implement, and advocate for policies, programmes, services, and research that support and benefit persons with a disability. Acknowledging that people with disability comprise a significant proportion of the world’s population, IFSW encourages the consideration of people with disabilities in all of its policies. IFSW also supports the following policy principles that promote the inclusion of all people with disabilities in all societies and communities.

  • IFSW endorses the CRPD and encourages all countries to sign the convention and the optional protocol
  • IFSW stresses and affirms the core commitment of the social work profession to human rights for people with disabilities including the elimination of physical, emotional, financial and sexual abuse, exploitation, and neglect,
  • IFSW supports the full participation of people with disabilities in the design, implementation, and evaluation of disability programmes, policies, and research.
  • IFSW supports the self determination of people with disabilities in all aspects of their lives
  • IFSW will work to promote the full inclusion of all people with disabilities, including people with physical, psychological, and cognitive disabilities, in all aspects of society including education, paid employment, community living, political participation, as well as cultural, and social activities.
  • IFSW will work to ensure that people with disability receive proper health and mental health care, primary and acute care, including effective medications and sexual health care; rehabilitative services and assistive technology; psychotherapy and substance abuse treatment; palliative and hospice care
  • IFSW supports the introduction, preservation, and strengthening of a range of public, private, and commercial income security schemes that safeguard adequate income to meet needs of people with disabilities especially women.
  • IFSW recognised the need to promote and expand disability education and training for all social workers and other health, mental health, and service providers.
  • IFSW strongly supports the full participation of persons with disability in the profession, in social work education, social policy and social agencies.
  • IFSW affirms that education of social workers should equip them to work alongside people with disability, families and the environment. Social workers should have the skills to recognize that every disabled person has her/ his own individuality and has the freedom to make their own choice. – practice, policy, research, and advocacy.

References

  • Braithwaite, J, Carroll, R., Mont, D. & Peffley, K. (2008). Disability & Development in the World Bank: FY2000–2007 SP Discussion Paper 0808. World Bank Publication.
  • Hoogeveen, J. (2005).Measuring Welfare for Small but Vulnerable Groups: Poverty and Disability in Uganda. Journal of African Economies, Vol. 14, No. 4, pp.603-631.
  • 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, 2003.
  • Pandey, Manoj K. (2009): Poverty and disability among Indian elderly: evidence from household survey. Unpublished report.