Let’s support the disabled

sorts of paraphernalia illegally at street corners in the country’s cities belies a deeper, and often unacknowledged social problem – the grinding poverty that is a permanent feature amongst people with disabilities (PWDs) in the developing word.

So pervasive, so multi-dimensional and so subtle in some of its aspects is the poverty that characterises the lives of PWDs that it is often referred to as the hidden face of African poverty. Although the generality of the public have yet to acknowledge it, so devastating is the impact of poverty on disability that it led Norman Acton, former Secretary General of Rehabilitation International, in 1983 to remark that, “The combination and poverty and disability is a fearsome one.
“Either one may cause the other and their presence in combination has a tremendous capacity to destroy the lives of persons with impairments and to impose on their families burdens that are too crushing to bear”.

Destroyed lives and crushing family burdens are terms that aptly capture the lives of people with disabilities, who, in the developing world, are estimated at 10 percent of the population but make up 20 percent of the world’s poorest. Poverty-related diseases, which are the major cause of a wide array of impairments, combine with attitudinal discrimination by the wider society to create a potent disabling force, that not only results in the discrimination and ostracising of people with disabilities, but also in the creation of institutional barriers that preclude access by people with disabilities to vital life opportunities including employment, education, health care and other vital services.

Banks will often not accept customers with disabilities, employers routinely discriminate against people with disabilities and even families have been known to exclude children with disabilities in the distribution of inheritance. Attitudinal discrimination also gives rise to environmental discrimination, exemplified by a physical environment which excludes PWDs.

Buildings with steps and narrow entrances, inaccessible public transport, a scarcity of information transcribed into Braille or available on audio tape and a lack of sign language translators – all these serve to keep PWDs out, relegated to the margins and without the information they need to participate equally in societal activities.

Analysis of case studies in some developing countries shows that higher disability rates are associated with higher illiteracy, poor nutrition status, lower inoculation and immunisation coverage, lower birth weight, higher unemployment and underemployment rates, and lower occupational mobility.

Comparisons indicate higher proportion of disability by communicable maternal and prenatal diseases and injuries and the proportion of childhood disability in developed countries. Regrettably, much of the disability in developing countries stems from preventable impairments, and a large part of the disability could be eliminated through treatment or alleviated through rehabilitation.

Contextually, poverty may also increase the likelihood that a health condition may result in disability.
In addition, stigma associated with a health condition may lead to activity limitations and participation restrictions given a particular social and cultural context and it might be worsened by the stigma

associated with poverty. Additionally, an inaccessible physical environment, makes it difficult for an individual with a disability to engage in activities and participate in the community.
The relationship between poverty and disability is well-documented, with disability being both a cause and a consequence of poverty. Not only does disability add to the risk of poverty, but conditions of poverty add to the risk of disability. Poor households do not have adequate food, basic sanitation and access to preventive health care. They live in lower quality housing, and work in more

dangerous occupations. Malnutrition can cause disability as well as increase susceptibility to other disabling diseases.
Malnourished mothers have low-birth weight babies, who are more at risk of debilitating diseases than healthy babies. Lack of adequate and timely health care can exacerbate disease outcomes, and a remedial impairment can become a permanent disability. Disability may lead to poverty due to lower access to work opportunities from the social discrimination and add significantly to the personal cost of work and social participation from expenses related to medical care, assistive technology, adaptations to home and work stations, transportation, and personal care.

There is also the issue of “courtesy poverty” arising from family members foregoing earnings and reproductive work as the result of time spent in the care of the family member with a disability.
Furthermore, the direct cost of disability is usually unequally shared. The burden of care most often falls on family members, usually mothers or other female relatives. Caring for a child with a severe disability further increases the workload of women living in extreme poverty, and takes valuable time away from the daily struggle to make a living.