4. Why a disability perspective should be included in all poverty reduction projects

This section aims to demonstrate that including the perspectives of persons with disabilities is crucial to success of any projects aimed at fighting poverty; firstly, because of the intractable link between poverty and disability, and secondly, because the Millennium Development Goals cannot be achieved without addressing disability (1).

Of the estimated over 600 million persons with disabilities worldwide, about 80% live in Developing Countries and 82% live below the poverty line (2).The World Bank estimates that persons with disabilities comprise about 20% of the poorest of the poor (3). The relationship has often been described in the literature as a vicious circle, with poverty leading to disability, and disability leading to, and deepening poverty.

The relationship between poverty and disability (1)
DISABILITY		Lack to access to informative and preventive and maternal healthcare food security, safe water and sanitation Increased exposure to disease, and lack of access to quality curative, habilitative and rehabilitation services Increased occupational risks/dangerous employment Higher risks in conflict situations and natural disasters/increased risk of injury/disability

Discrimination in alla spects of file Lack of access to education and training Exclusion from the job market Higher risks in conflict situations and natural disasters Difficulties for accessing food, water and sanitation Lack of access to rehabilitation/habitation to achieve independent living Lack of voice/influence/choices		POVERTY

Poverty as a cause of disability

According to WHO, DFID and World Bank estimates (2000), 50% of impairments leading to disabilities are preventable and directly related to poverty. In 2006, 100 million people in the world acquired a disability due to malnutrition; malnutrition and disability and poverty are inextricably intertwined (4).

Disability leads to poverty and deepens poverty at individual, family, community and the global level

Disability and poverty at the individual level

People living in poor communities are more at risk of impairment leading to disability because of lack of access to adequate nutrition, preventative, curative and maternal health care, water and sanitation, safe employment or security in conflict and natural disasters.
An adult or child living with a disability is likely to be discriminated against and denied their right to education which leads to exclusion from the social and economic life of the community and eventual unemployment, which deepens poverty. Importantly, persons with disabilities rarely get the opportunity to voice their views and influence decisions affecting their lives. They are often excluded from development programmes and face big difficulties in breaking out of the circle of poverty and disability.
From an economic point of view, an individual experiences a doubling of the cost of disability: Firstly, there are direct costs for treatment or rehabilitation, including user fees and transport costs. Secondly, income is foregone- potentially both for the person with disability and their assistants or families.

Disability and poverty at family and community level

It is estimated that one out of four persons has a family member with a disability; the lives of 25% of the population in the Asia-Pacific region are believed to be impacted by disability (5). Rates of poverty are known to be higher in households with a person with disability. Household members spend time and money taking care of their family member who needs personal assistance and has not had access to support services or rehabilitation which would lead to independent living. Family members may be kept from economic activities, school, etc (6).

Disability and poverty at the global level

In 1993, the UN estimated that 25% of the entire population is adversely affected in one way or another as a result of disabilities (7). World Bank studies estimated the global GDP loss due to disability from $1.71 trillion to $2.23 trillion annually (8) and that developing countries experience from 12- to 20% of their population as non-productive due to disability (9).

Disability and MDGs (10)

The international development community has made a commitment to achieve the MDGs; this cannot be done without including the perspectives of persons with disability.

MDG 1: Eradicate Hunger and Poverty

Persons with disabilities make up as much as one-fifth of the people living in poverty worldwide (11). If we ignore persons with disability in poverty reduction programmes, we ignore 20% of the world's poorest most excluded people.

MDG 2: Achieve Universal Primary Education

The Education for All Global Monitoring report (12) states that one third of out of school children has a disability. How will we reach universal primary education without a concerted effort to get children with disability to school?

MDG 3: Promote Gender Equality and Empower Women

Women and girls with disabilities are more likely to be victims of sexual abuse. Only one percent of women with disabilities is estimated to be literate. The fight for gender equality should therefore put emphasis on redressing the inequalities faced by the most discriminated against women.

MDG 4: Reduce Child Mortality

Mortality for children with disabilities can be as high as 80% even in countries where under-five mortality is below 20% (13). Every child should have an equal right to life. Should all efforts to reduce child mortality not pay particular attention to the most disadvantaged children?

MDG 5: Improve Maternal Health

UNFPA estimates that as many as 20 million women per year develop a disability or long-term complications as a result of pregnancy and childbirth (14). Abnormal pre-natal or peri-natal events are a major cause of disability in children. A large number of peri-natal disabilities in children can be prevented by training midwives and birth attendants (15). Improved maternal healthcare will reduce disability both for women and for children.

MDG 6: Combat HIV/AIDS, Malaria, TB and other Diseases

In the global flight against HIV & AIDS, TB and other diseases, persons with disabilities are largely excluded; both from prevention and treatment. Persons with disabilities make up 10% of any given population (WHO) and they are more exposed to every risk factor for HIV and AIDS (16). How can they still be excluded from reproductive health and disease prevention programmes?

MDG 7: Ensure Environmental Sustainability

Access to natural resources and the impact of climate change affects persons with disabilities as part of the overall population. Given their often marginalised position in society, the impact on persons with disabilities can be even greater.

MDG 8: Develop a Global Partnership for Development

If the Global Partnership for Development is aimed at poverty reduction- then it is essential that persons with disabilities are involved.

(1) DFID: How to note, a DFID Practice Paper ; working on Disability in Country Programmes. 2007. http://www.dfid.gov.uk/pubs/files/DisguideDFID.pdf
(2) Hope, T: Disabilities : Aid groups call for a UN Convention to protect rights', UNWire. 2003
(3) Elwan, A.: Poverty and Disability : a survey of literature. World Bank. 1999
(4) DFID: Disability, poverty and development. 2000. www.dfid.gov.uk/pubs/files/disabilities.pdf
(5) Asian Development Bank (ADB): Regional workshop on Disability and Development - draft recommendations on Disability, Manila, October 2002
(6) The World Bank: Social Analysis and Disability: a guidance note. Incorporating disability-inclusive development into Bank-supported projects; 2007, p. 10
(7) DFID. 2000 (op. cit)
(8) Berman Bieler, R.: The MDGs, Disability &Inclusive Development World, Inter-American Institute on Disability & Inclusive Development, October 2006, Presentation. http://siteresources.worldbank.org/DISABILITY/Resources/News---Events/463933-1163109717105/RBB_WCCD.pdf
(9) Source: The World Bank. 2007(op. cit)
(10) Adapted from: The World Bank: Social Analysis and Disability (op. cit) and Guernsey, N. et al: Make inclusion operational, the World Bank, Legal and Institutional Resources for World Bank Staff on the Inclusion of Disability Issues in Investment Projects. 2006
(11) Elwan, A.: Poverty and Disability; A survey of the Literature. The World Bank. 1999. http://siteresources.worldbank.org/INTPOVERTY/Resources/WDR/Background/elwan.pdf
(12) UNESCO: EFA Global Monitoring Report 2007 features early childhood care and education. http://unesdoc.unesco.org/images/0014/001477/147794E.pdf
(13) DFID: 2000 (op.cit.)
(14) UN Population Fund (UNFPA): UNFPA Promotes Safe Motherhood. http://www.unfpa.org/rh/mothers/index.htm, cited in ACFID: ACFID Issues Paper. Disability and the Millennium Development Goals. 2007. http://www.acfid.asn.au/what-we-do/docs_what-we-do/docs_issues/docs_disability-and-development/disability-and-mdgs.pdf
(15) INFPA, cited in ADFID 2007 (op. cit.)
(16) Yale/World Bank Global Survey on HIV/AIDS and Disability http://cira.med.yale.edu/globalsurvey

This manual is part of the project "Disability mainstreaming in Development Cooperation", supported by DG Employment and Social Affairs of the European Commission. The contents of this manual are the sole responsibility of CBM.